EP16.33: Postpartum uterine artery Doppler velocimetry in patients undergoing conservative management of placenta accreta spectrum

To describe the uterine circulation after delivery in women with severe placenta accreta spectrum (PAS) undergoing conservative management. 27 patients underwent conservative management for PAS. After Caesarean delivery, patients were closely monitored at 1-2 week intervals until either hysterectomy or reabsorption occurred. At each clinical visit, Doppler velocimetry of the uterine arteries (UtA) was performed and the mean (m) peak systolic (PSV) and end-diastolic velocities (EDV), as well as the pulsatility index (PI), were calculated. Two sets of analyses were conducted: 1) comparing patients with and without bleeding complications (readmission due to bleeding, or an estimated blood loss > 500cc at the time of interval hysterectomy), and 2) comparing those who were able or not to retain their uterus. 17/27 patients (62%) chose to preserve their uterus, while 10 (38%) opted for a delayed hysterectomy. In the entire group, there was a decrease in UtA mPSV and mEDV, and an increase in mPI over time. The mean UtA PI values were significantly lower than the reference standards for postpartum women. 13/27 patients (48%) experienced bleeding complications. These patients had a lower UtA mPI (0.66 vs. 0.79; p = 0.03) and slightly higher, but not significantly different, mPSV (102.5 vs. 94.75 cm/s; p = 0.3) and mEDV (69.8 vs 56.4; p = 0.4) compared to those without bleeding complications. Patients with successful uterine preservation (8/17, 47%) had higher UtA mPI (1.15 vs. 0.8; p = 0.001) and lower but not significantly different UtA mPSV (98.6 vs 108.6 cm/s; p = 0.1) and mEDV (61.8 vs 91.7 cm/s; p = 0.1) than those who could not retain the uterus. In women with severe PAS undergoing conservative management, those with bleeding complications or those who were unable to retain their uterus, had lower mean pulsatility index (PI) and higher velocities in the uterine artery (UtA) compared to women without bleeding complications or those who were able to successfully retain their uterus.